Nephrology Practice Questions

Q: All of the following are used for the treatment of hyperkalemia except?

Beta blockers. **Explanation:** The management of hyperkalemia focuses on three goals: stabilizing the cardiac membrane, shifting potassium into cells, and removing potassium from the body [1]. **Why Beta-blockers are the correct answer:** Beta-blockers (specifically non-selective ones) **worsen** hyperkalemia. Under normal physiological conditions, $\beta_2$-adrenergic receptors stimulate the Na+/K+-ATPase pump, which drives potassium into the intracellular compartment. Beta-blockers inhibit this process, leading to an increase in serum potassium levels. In contrast, **$\beta_2$-agonists** (like nebulized Salbutamol) are used as a treatment to shift potassium into cells. **Analysis of other options:** * **Calcium gluconate:** This is the first-line treatment for hyperkalemia with ECG changes [1]. It does not lower potassium levels but **stabilizes the myocardial membrane** by antagonizing the effects of potassium on the cardiac conduction system [1]. * **Sodium bicarbonate:** It promotes the movement of potassium into cells by increasing the blood pH (alkalosis). As hydrogen ions ($H^+$) move out of cells to buffer the alkalosis, potassium ($K^+$) moves into the cells to maintain electroneutrality. * **IV Glucose with Insulin:** Insulin is a potent stimulator of the Na+/K+-ATPase pump. Glucose is co-administered to prevent hypoglycemia. This is one of the fastest ways to shift potassium intracellularly. **NEET-PG Clinical Pearls:** 1. **"C Big K" Mnemonic** for treatment: **C**alcium gluconate, **B**icarbonate, **I**nsulin/Glucose, **G**-agonists (Salbutamol), **K**ayexalate (Resins), and **K**idney dialysis. 2. **Calcium gluconate vs. Calcium chloride:** Calcium gluconate is preferred via peripheral lines as it is less caustic to veins. 3. **Definitive removal:** While insulin and bicarbonate shift potassium, **Loop diuretics** and **Hemodialysis** are required for actual elimination from the body.

Q: A patient presents with hematuria for many days. Investigations reveal renal calculi, calcifications in the wall of the urinary bladder, and a small contracted bladder. What is the most probable cause?

Schistosomiasis. ### Explanation The clinical triad of **hematuria**, **bladder wall calcification**, and a **small contracted bladder** in the presence of renal calculi is a classic presentation of **Schistosomiasis** (specifically *Schistosoma haematobium*) [1]. #### Why Schistosomiasis is Correct? * **Pathogenesis:** The adult flukes reside in the perivesical venous plexus [1]. Eggs are deposited in the bladder wall, inducing a granulomatous reaction and chronic inflammation. * **Calcification:** As the eggs die, they undergo calcification. On imaging, this appears as a characteristic "fetal head" or linear calcification of the bladder wall. * **Contracted Bladder:** Chronic inflammation leads to extensive fibrosis, reducing bladder capacity and compliance (thimble bladder). * **Calculi:** Urinary stasis and the presence of calcified eggs acting as a nidus frequently lead to secondary stone formation [3]. #### Why Other Options are Incorrect? * **Tuberculosis (TB):** While TB causes a "thimble bladder" and hematuria, the calcification in TB typically involves the **renal parenchyma** (putty kidney) or ureters rather than the bladder wall itself [3]. * **Amyloidosis:** Can cause bladder thickening and hematuria [2], but diffuse bladder wall calcification is not a characteristic feature. * **Carcinoma of the Bladder:** While *S. haematobium* is a risk factor for **Squamous Cell Carcinoma**, the primary presentation of a tumor is a filling defect or mass rather than diffuse wall calcification and contraction. #### High-Yield Clinical Pearls for NEET-PG * **Vector:** *Bulinus* snail. * **Infective stage:** Cercaria (penetrates skin during swimming) [1]. * **Diagnostic feature:** Terminal spined eggs in urine. * **Malignancy Risk:** Strongly associated with **Squamous Cell Carcinoma** of the bladder (unlike the more common Transitional Cell Carcinoma). * **Drug of Choice:** Praziquantel.

Q: A 31-year-old woman experiences abdominal pain 1 week after noticing blood in her urine. She has had three episodes of urinary tract infection during the past year. Urinalysis shows 2+ hematuria, 1+ proteinuria, hypercalciuria, and no glucose or ketones. Microscopic examination of the urine shows numerous RBCs and oxalate crystals. An abdominal CT scan with contrast shows linear striations radiating into the renal papillae, along with small cystic collections of contrast material in dilated collecting ducts. She is advised to increase her daily intake of fluids, and her condition improves. Which of the following renal cystic diseases is most likely to be associated with these findings?

Medullary sponge kidney. The clinical presentation and imaging findings are classic for **Medullary Sponge Kidney (MSK)**. MSK is a congenital (usually sporadic) disorder characterized by ectasia (dilation) of the pre-calyceal collecting ducts in the renal papillae [1]. **Why Medullary Sponge Kidney is correct:** * **Imaging:** The "linear striations" and "cystic collections of contrast" in the papillae are pathognomonic. On IVP or contrast CT, this is often described as a **"bouquet of flowers"** or **"paint brush"** appearance [1]. * **Clinical Features:** Patients are often asymptomatic until adulthood, presenting with **recurrent UTIs** and **nephrolithiasis** (calcium oxalate stones) [1], [3]. * **Pathophysiology:** Urinary stasis in the dilated ducts leads to stone formation. Hypercalciuria and distal renal tubular acidosis (dRTA) are common metabolic associations [3]. **Why other options are incorrect:** * **ADPKD:** Presents with large, bilateral cortical and medullary cysts that significantly increase kidney size and often lead to renal failure [2]. It does not show the specific papillary "striation" pattern. * **ARPKD:** Typically presents in infancy/childhood with bilateral enlarged kidneys and hepatic fibrosis. * **Multicystic Renal Dysplasia:** Usually a unilateral, non-genetic condition found in neonates where the kidney is replaced by large cysts and lacks a functioning pelvicalyceal system. **High-Yield Pearls for NEET-PG:** * **Diagnosis:** Best initial/traditional test is Intravenous Pyelography (IVP); CT urography is the modern standard [1]. * **Metabolic Association:** Associated with **Type 1 (Distal) RTA** and hypercalciuria [3]. * **Prognosis:** Generally benign with a normal life expectancy; management focuses on hydration to prevent stones [1]. * **Key Buzzword:** "Paint brush appearance" of the renal papillae [1].

Q: Rhabdomyolysis is seen in all of the following conditions except?

Hyperphosphatemia. Rhabdomyolysis is a clinical syndrome involving the breakdown of skeletal muscle fibers with the release of intracellular contents (myoglobin, CPK, and electrolytes) into the circulation. **Why Hyperphosphatemia is the correct answer:** Hyperphosphatemia is a **consequence** of rhabdomyolysis, not a cause. When muscle cells lyse, they release large amounts of intracellular phosphate into the bloodstream. Other metabolic consequences include hyperkalemia, hyperuricemia, and hypocalcemia (initially). Therefore, while it is a hallmark finding in the lab results of a patient with rhabdomyolysis, it does not trigger the condition itself. **Analysis of other options (Causes of Rhabdomyolysis):** * **Prolonged seizure activity:** Excessive muscle hyperactivity leads to an imbalance between ATP demand and supply, resulting in muscle cell death. * **Severe hypothyroidism:** Myopathy is common in hypothyroidism. In severe cases (like Myxedema coma), it can progress to frank rhabdomyolysis due to impaired muscle metabolism and reduced mitochondrial activity. * **Myopathy:** Various underlying myopathies (inflammatory like polymyositis, or metabolic like McArdle disease) predispose the sarcolemma to injury, leading to rhabdomyolysis [1]. **NEET-PG High-Yield Pearls:** * **Triad:** Muscle pain, weakness, and dark (tea-colored) urine. * **Gold Standard Lab:** Serum Creatine Phosphokinase (CPK) levels >5 times the upper limit of normal. * **Renal Complication:** Acute Tubular Necrosis (ATN) caused by myoglobinuria. * **Urinalysis Clue:** Dipstick positive for blood but **microscopy negative** for RBCs (indicates myoglobinuria). * **Treatment Priority:** Aggressive IV fluid resuscitation to prevent Pigment-induced Acute Kidney Injury.

Question 1

What is the most common cause of chronic renal failure in adults?

Accepted Answer

Diabetes Mellitus

Answer

Tuberculosis

Answer

Hypertension

Answer

Glomerulonephritis

Question 2

All of the following are used for the treatment of hyperkalemia except?

Accepted Answer

Beta blockers

Answer

Calcium gluconate

Answer

Sodium bicarbonate

Answer

Intravenous infusion of glucose with insulin

Question 3

Hypertension with hypokalemia is typically seen in which of the following conditions?

Accepted Answer

Liddle's Syndrome

Answer

Bartter Syndrome

Answer

Gitelman's Syndrome

Answer

All of the above

Question 4

A patient presents with hematuria for many days. Investigations reveal renal calculi, calcifications in the wall of the urinary bladder, and a small contracted bladder. What is the most probable cause?

Accepted Answer

Schistosomiasis

Answer

Amyloidosis

Answer

Tuberculosis

Answer

Carcinoma of the urinary bladder

Question 5

Nephrocalcinosis is a feature of which of the following conditions?

Accepted Answer

Pseudohypoparathyroidism

Answer

Primary hyperparathyroidism

Answer

Medullary sponge kidney

Answer

Vitamin D intoxication

Question 6

A 31-year-old woman experiences abdominal pain 1 week after noticing blood in her urine. She has had three episodes of urinary tract infection during the past year. Urinalysis shows 2+ hematuria, 1+ proteinuria, hypercalciuria, and no glucose or ketones. Microscopic examination of the urine shows numerous RBCs and oxalate crystals. An abdominal CT scan with contrast shows linear striations radiating into the renal papillae, along with small cystic collections of contrast material in dilated collecting ducts. She is advised to increase her daily intake of fluids, and her condition improves. Which of the following renal cystic diseases is most likely to be associated with these findings?

Accepted Answer

Medullary sponge kidney

Answer

Autosomal dominant polycystic kidney disease

Answer

Autosomal recessive polycystic kidney disease

Answer

Multi-cystic renal dysplasia

Question 7

Central nervous system manifestations in chronic renal failure are a result of all of the following except:

Accepted Answer

Hypocalcemia

Answer

Hyperosmolarity

Answer

Acidosis

Answer

Hyponatremia

Question 8

What is the most common metabolic abnormality predisposing patients to renal stone formation?

Accepted Answer

Hypercalciuria

Answer

Hyperuricemia

Answer

Distal renal tubular acidosis

Answer

Increased urine volume

Question 9

In uremia, all of the following are reversed by dialysis except:

Accepted Answer

Sexual dysfunction

Answer

Pericarditis

Answer

Uremic lung

Answer

Neuropathy

Question 10

Rhabdomyolysis is seen in all of the following conditions except?

Accepted Answer

Hyperphosphatemia

Answer

Prolonged seizure activity

Answer

Severe hypothyroidism

Answer

Myopathy

Nephrology — MCQs

Nephrology — MCQs

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